Racialized economic concentration predicts storm-related injuries and deaths in the United States, 2005–2022

Extreme storms across the United States pose substantial and unequally distributed health burdens. We linked 111,252 county-event observations from the US National Oceanic and Atmospheric Administration Storm Events Database (2005–2022) to the Index of Concentration at the Extremes (ICE), a measure of racialized economic concentration reflecting the relative concentration of high-income non-Hispanic White households compared with low-income Black households within U.S. counties, to examine whether ICE predicts storm-related injuries and deaths. Using multilevel zero-inflated negative binomial models with county random intercepts and population offsets, each one-quintile increase in ICE (greater concentration of high-income, non-Hispanic White households relative to low-income Black households) was associated with 52% lower rates of direct injuries (IRR = 0.48, 95% CI: [0.44, 0.53]) and 36% lower rates of direct deaths (IRR = 0.64, 95% CI: [0.59, 0.69]). Associations for indirect outcomes were less precise but directionally consistent (indirect injuries IRR = 0.70, 95% CI: [0.54, 0.91]; indirect deaths IRR = 0.66, 95% CI: [0.48, 0.89]). Spline models suggested elevated risk concentrated in the most disadvantaged counties, with risk flattening in more advantaged areas. County-level maps show that structural disadvantage and storm exposure frequency do not systematically co-locate, suggesting that realized harm is driven by social and infrastructural context rather than exposure alone. These findings identify racialized economic concentration as a structural determinant of disaster harm and support targeting resilience investments toward the most structurally disadvantaged and economically marginalized counties. Extreme storms increasingly threaten public health across the United States. This study found that counties with greater racialized economic disadvantage experienced markedly higher rates of storm-related injuries and deaths.